| NPI | 1649679689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 299769) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 037880) |
| Enumeration Date | 2014-08-15 |
| Last Update Date | 2024-03-25 |